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Szulc P, Lewis JR, Chapurlat R. Decline in muscle strength and physical function after fracture in men - the prospective STRAMBO study. J Bone Miner Res 2024; 39:252-259. [PMID: 38477746 DOI: 10.1093/jbmr/zjae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 03/14/2024]
Abstract
Studies on muscle strength and physical function after fracture are focused on short follow-ups and adjacent anatomical region. We compared loss of muscle strength and physical function in men after fracture with normal ageing-related decline. In 823 men aged 60-87, measurements of grip strength and clinical tests (chair stands, balance) were performed every 4 years for 12 years. In 155 men with incident fracture, we compared the status after vs. before the fracture. In men without fracture (controls), we compared the status on the first follow-up (4 years) vs. baseline. In men with fracture, grip strength decreased more than in the controls (41%, 0.28SD, P < .01). Men with fracture had higher risk of incident deterioration on the five chair-stand test vs. the controls (OR = 2.45, P < .001). They had higher risk of incident inability to stand for 10s with closed eyes vs. the controls (OR = 4.80, P < .01). They also had higher risk of deterioration on the tandem walk than the controls: forwards (OR = 2.04, P < .01), backwards (OR = 2.25, P < .005). The rapid physical decline was not limited to the region of the fracture site. In men who had incident non-upper limb fractures, grip strength decreased more (32%, P < .05) vs. the controls. In men who had incident non-lower limb fractures, the risk of decline in the tests of the lower limbs was higher vs. controls (chair stands, OR = 2.73, P < .001). The risk of decline was higher in men with clinical fractures which occurred >1 year before the next visit vs. controls (tandem walk forwards, OR = 2.98, P < .005). Overall, in older men, fractures were associated with greater loss of muscle strength and physical function vs. normal ageing. This accelerated decline was also found in the anatomical regions remote from the fracture site. Thus, programs to decrease or reverse the post-fracture decline could have beneficial effects on subsequent fracture risk.
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Affiliation(s)
- Paweł Szulc
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon, Place d'Arsonval, France
| | - Joshua R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth WA 6027, Australia
| | - Roland Chapurlat
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon, Place d'Arsonval, France
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Kanis JA, Johansson H, McCloskey EV, Liu E, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, Mellström D, Merlijn T, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Vandenput L, Harvey NC, Lorentzon M, Leslie WD. Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX. Osteoporos Int 2023; 34:2027-2045. [PMID: 37566158 PMCID: PMC7615305 DOI: 10.1007/s00198-023-06870-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023]
Abstract
A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. INTRODUCTION The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). METHODS We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted β-coefficients. RESULTS A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72-2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69-2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63-2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62-2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. CONCLUSION A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.
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Affiliation(s)
- J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| | - H Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - E Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - K E Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - F A Anderson
- GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - R Azagra
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Health Centre Badia del Valles, Catalan Institute of Health, Barcelona, Spain
- PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain
| | - C L Bager
- Nordic Bioscience A/S, Herlev, Denmark
| | - C Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Department of Health Services Research, University of Maastricht, Maastricht, the Netherlands
| | - H A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
- Centre on Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
| | - E Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - O Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - J R Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - R Chapurlat
- INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
| | | | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
| | - C J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - S R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - J A P da Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - B Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - A Diez-Perez
- Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
| | - A B Dufour
- Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - J A Eisman
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - P J M Elders
- Petra JM Elders Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Y Fujita
- Center for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan
| | - S Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - C-C Glüer
- Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - I Goldshtein
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - J Hall
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - D Hans
- Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland
| | - M Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim, Norway
| | - R J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | - M Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - M Iki
- Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
| | - S Ish-Shalom
- Endocrine Clinic, Elisha Hospital, Haifa, Israel
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - S Khosla
- Robert and Arlene Kogod Center on Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D P Kiel
- Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - W-P Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - F Koromani
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M A Kotowicz
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Department of Medicine -Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - H Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - T Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - O Lamy
- Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - A Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - K Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
| | - T Merlijn
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - A Nordström
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - P Nordström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - T W O'Neill
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - B Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - C Ohlsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - E S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - J A Pasco
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Department of Medicine -Western Health, The University of Melbourne, St Albans, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - F Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A-M Schott
- Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
| | - E J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - K Siggeirsdottir
- Icelandic Heart Association, Kopavogur, Iceland
- Janus Rehabilitation, Reykjavik, Iceland
| | - E M Simonsick
- Translational Gerontology Branch, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - E Sornay-Rendu
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - K M A Swart
- Petra JM Elders Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - J Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - N M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - T P van Staa
- Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Vila
- Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - N J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - N C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - M C Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Zwart
- PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain
- Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- GROIMAP/GROICAP (research groups), Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain
| | - L Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - M Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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3
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Vandenput L, Johansson H, McCloskey EV, Liu E, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, Mellström D, Merlijn T, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schei B, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Harvey NC, Lorentzon M, Leslie WD, Kanis JA. Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan. Osteoporos Int 2022; 33:2103-2136. [PMID: 35639106 DOI: 10.1007/s00198-022-06435-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/18/2022] [Indexed: 12/15/2022]
Abstract
UNLABELLED We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. INTRODUCTION The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. METHODS A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. RESULTS Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. CONCLUSIONS These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).
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Affiliation(s)
- L Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - E Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - K E Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - F A Anderson
- GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - R Azagra
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Health Center Badia del Valles, Catalan Institute of Health, Barcelona, Spain
- GROIMAP (Research Group), Unitat de Suport a La Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Santa Coloma de Gramenet, Barcelona, Spain
| | - C L Bager
- Nordic Bioscience A/S, Herlev, Denmark
| | - C Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - H A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
- Centre On Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
| | - E Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - O Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - J R Center
- Bone Biology, Healthy Ageing Theme, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - R Chapurlat
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | | | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health Research Oxford Biomedical Research Unit, , University of Oxford, Oxford, UK
| | - C J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - S R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - J A P da Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Rheumatology Department, University Hospital and University of Coimbra, Coimbra, Portugal
| | - B Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA
| | - A Diez-Perez
- Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
| | - A B Dufour
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - J A Eisman
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - P J M Elders
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Y Fujita
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | - S Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - C-C Glüer
- Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - I Goldshtein
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - J Hall
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - D Hans
- Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - M Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim, Norway
| | - R J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | - M Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - M Iki
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | - S Ish-Shalom
- Endocrine Clinic, Elisha Hospital, Haifa, Israel
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - S Khosla
- Robert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D P Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - W-P Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - F Koromani
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M A Kotowicz
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - H Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - T Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - O Lamy
- Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - A Langhammer
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - K Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
| | - T Merlijn
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - A Nordström
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- School of Sport Sciences, Arctic University of Norway, Tromsø, Norway
| | - P Nordström
- Unit of Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - T W O'Neill
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - B Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - C Ohlsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - E S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - J A Pasco
- Institute for Physical and Mental Health and Clinical Translation (IMPACT), Deakin University, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
- Barwon Health, Geelong, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - F Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Gynecology, St Olavs Hospital, Trondheim, Norway
| | - A-M Schott
- Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
| | - E J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA
| | - K Siggeirsdottir
- Icelandic Heart Association, Kopavogur, Iceland
- Janus Rehabilitation, Reykjavik, Iceland
| | - E M Simonsick
- Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA
| | | | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - K M A Swart
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - J Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - N M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - T P van Staa
- Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Vila
- Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - N J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - N C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - M C Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Zwart
- Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- GROIMAP (Research Group), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
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Piot A, Plotton I, Boutroy S, Bacchetta J, Ailloud S, Lejeune H, Chapurlat RD, Szulc P, Confavreux CB. Klinefelter Bone Microarchitecture Evolution with Testosterone Replacement Therapy. Calcif Tissue Int 2022; 111:35-46. [PMID: 35152305 DOI: 10.1007/s00223-022-00956-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/04/2022] [Indexed: 11/02/2022]
Abstract
Klinefelter Syndrome (KS) patients, defined by a 47 XXY karyotype, have increased risk of fragility fractures. We have assessed bone microarchitecture by high resolution peripheral quantitative CT (HR-pQCT) at the radius and tibia in young KS patients, naïve from testosterone replacement therapy (TRT). Areal bone mineral density (BMD) and body composition were assessed by dual X-ray absorptiometry (DXA). Total testosterone (tT) was measured at baseline. Bone measurements have been repeated after 30 months of TRT. We enrolled 24 KS patients and 72 age-matched controls. KS patients were (mean ± SD) 23.7 ± 7.8 year-old. KS patients had significantly lower relative appendicular lean mass index (RALM) and lower aBMD at spine and hip than controls. Ten patients (42%) had low tT level (≤ 10.4 nmol/L). At baseline, we observed at radius a marked cortical (Ct) impairment reflected by lower Ct.area, Ct.perimeter, and Ct.vBMD than controls. At tibia, in addition to cortical fragility, we also found significant alterations of trabecular (Tb) compartment with lower trabecular bone volume (BV/TV) and Tb.vBMD as compared to controls. After 30 months of TRT, 18 (75%) KS patients were reassessed. Spine aBMD and RALM significantly increased. At radius, both cortical (Ct.Pm, Ct.Ar, Ct.vBMD, Ct.Th) and trabecular (Tb.vBMD) parameters significantly improved. At tibia, the improvement was found only in the cortical compartment. Young TRT naïve KS patients have inadequate bone microarchitecture at both the radius and tibia, which can improve on TRT.
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Affiliation(s)
- A Piot
- Département de Rhumatologie, Hospices Civils de Lyon, Lyon, France
- INSERM UMR 1033, Université de Lyon, Lyon, France
| | - I Plotton
- Hormonologie et Endocrinologie Moleculaire et Maladies Rares, Hospices Civils de Lyon, Lyon, France
- Départment de Médecine de la Reproduction, Hospices Civils de Lyon, Lyon, France
- INSERM UMR 1208, Université de Lyon, Lyon, France
| | - S Boutroy
- INSERM UMR 1033, Université de Lyon, Lyon, France
| | - J Bacchetta
- INSERM UMR 1033, Université de Lyon, Lyon, France
- Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France
| | - S Ailloud
- Département de Rhumatologie, Hospices Civils de Lyon, Lyon, France
| | - H Lejeune
- Départment de Médecine de la Reproduction, Hospices Civils de Lyon, Lyon, France
- INSERM UMR 1208, Université de Lyon, Lyon, France
| | - R D Chapurlat
- Département de Rhumatologie, Hospices Civils de Lyon, Lyon, France
- INSERM UMR 1033, Université de Lyon, Lyon, France
| | - P Szulc
- INSERM UMR 1033, Université de Lyon, Lyon, France
| | - C B Confavreux
- Département de Rhumatologie, Hospices Civils de Lyon, Lyon, France.
- INSERM UMR 1033, Université de Lyon, Lyon, France.
- Service de Rhumatologie Sud, Centre Hospitalier Lyon Sud, 165, Chemin du Grand Revoyet, 69310, Pierre Bénite, France.
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Chotiyarnwong P, McCloskey EV, Harvey NC, Lorentzon M, Prieto-Alhambra D, Abrahamsen B, Adachi JD, Borgström F, Bruyere O, Carey JJ, Clark P, Cooper C, Curtis EM, Dennison E, Diaz-Curiel M, Dimai HP, Grigorie D, Hiligsmann M, Khashayar P, Lewiecki EM, Lips P, Lorenc RS, Ortolani S, Papaioannou A, Silverman S, Sosa M, Szulc P, Ward KA, Yoshimura N, Kanis JA. Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group. Arch Osteoporos 2022; 17:87. [PMID: 35763133 PMCID: PMC9239944 DOI: 10.1007/s11657-022-01117-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures. INTRODUCTION The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture. METHODS The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation's Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized. RESULTS AND CONCLUSION The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.
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Affiliation(s)
- P Chotiyarnwong
- Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - E V McCloskey
- Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
- Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK.
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - M Lorentzon
- University of Gothenburg, Gothenburg, Sweden
- Australian Catholic University, Melbourne, Australia
| | - D Prieto-Alhambra
- Oxford NIHR Biomedical Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
- GREMPAL (Grup de Recerca en Malalties Prevalents de L'Aparell Locomotor) Research Group, CIBERFes and Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Gran Via de Les Corts Catalanes, 591 Atico, 08007, Barcelona, Spain
| | - B Abrahamsen
- Department of Clinical Research, Odense Patient Data Exploratory Network, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - J D Adachi
- Department of Medicine, Michael G DeGroote School of Medicine, St Joseph's Healthcare-McMaster University, Hamilton, ON, Canada
| | - F Borgström
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - O Bruyere
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J J Carey
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - P Clark
- Clinical Epidemiology Unit of Hospital Infantil de México Federico Gómez-Faculty of Medicine, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - E M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - E Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - M Diaz-Curiel
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - H P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - D Grigorie
- Carol Davila University of Medicine, Bucharest, Romania
- Department of Endocrinology & Bone Metabolism, National Institute of Endocrinology, Bucharest, Romania
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - P Khashayar
- Center for Microsystems Technology, Imec and Ghent University, 9050, Ghent, Belgium
| | - E M Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - P Lips
- Department of Internal Medicine, Endocrine Section & Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R S Lorenc
- Multidisciplinary Osteoporosis Forum, SOMED, Warsaw, Poland
| | - S Ortolani
- IRCCS Istituto Auxologico, UO Endocrinologia E Malattie del Metabolismo, Milano, Italy
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- GERAS Centre for Aging Research, Hamilton, ON, Canada
| | - S Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - M Sosa
- Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Hospital University Insular, Las Palmas, Gran Canaria, Spain
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - K A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22Nd Century Medical and Research Center, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - J A Kanis
- Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK
- Australian Catholic University, Melbourne, Australia
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van den Bergh JP, Szulc P, Cheung AM, Bouxsein M, Engelke K, Chapurlat R. The clinical application of high-resolution peripheral computed tomography (HR-pQCT) in adults: state of the art and future directions. Osteoporos Int 2021; 32:1465-1485. [PMID: 34023944 PMCID: PMC8376700 DOI: 10.1007/s00198-021-05999-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
High-resolution peripheral computed tomography (HR-pQCT) was developed to image bone microarchitecture in vivo at peripheral skeletal sites. Since the introduction of HR-pQCT in 2005, clinical research to gain insight into pathophysiology of skeletal fragility and to improve prediction of fractures has grown. Meanwhile, the second-generation HR-pQCT device has been introduced, allowing novel applications such as hand joint imaging, assessment of subchondral bone and cartilage thickness in the knee, and distal radius fracture healing. This article provides an overview of the current clinical applications and guidance on interpretation of results, as well as future directions. Specifically, we provide an overview of (1) the differences and reference data for HR-pQCT variables by age, sex, and race/ethnicity; (2) fracture risk prediction using HR-pQCT; (3) the ability to monitor response of anti-osteoporosis therapy with HR-pQCT; (4) the use of HR-pQCT in patients with metabolic bone disorders and diseases leading to secondary osteoporosis; and (5) novel applications of HR-pQCT imaging. Finally, we summarize the status of the application of HR-pQCT in clinical practice and discuss future directions. From the clinical perspective, there are both challenges and opportunities for more widespread use of HR-pQCT. Assessment of bone microarchitecture by HR-pQCT improves fracture prediction in mostly normal or osteopenic elderly subjects beyond DXA of the hip, but the added value is marginal. The prospects of HR-pQCT in clinical practice need further study with respect to medication effects, metabolic bone disorders, rare bone diseases, and other applications such as hand joint imaging and fracture healing. The mostly unexplored potential may be the differentiation of patients with only moderately low BMD but severe microstructural deterioration, which would have important implications for the decision on therapeutical interventions.
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Affiliation(s)
- J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
- Faculty of Medicine, Hasselt University, Hasselt, Belgium.
| | - P Szulc
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 cedex 03, Lyon, France
| | - A M Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network; and Department of Medicine and Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, Ontario, Canada
| | - M Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - K Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 cedex 03, Lyon, France
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Szczepaniak OM, Kobus-Cisowska J, Nowosad K, Stuper-Szablewska K, Markowska J, Szulc P. Relationship of colour with the phytocompounds present in Cornus mas cultivars. International Journal of Food Properties 2021. [DOI: 10.1080/10942912.2021.1898420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- O. M. Szczepaniak
- Department of Gastronomy Sciences and Functional Foods, Faculty of Food Science and Nutrition, Poznań University of Life Sciences, Poznań, Poland
| | - J. Kobus-Cisowska
- Department of Gastronomy Sciences and Functional Foods, Faculty of Food Science and Nutrition, Poznań University of Life Sciences, Poznań, Poland
| | - K. Nowosad
- Department of Genetics, Plant Breeding and Seed Production, the Faculty of Life Sciences and Technology, Wrocław University of Life and Environmental Studies, Wrocław, Poland
| | - K. Stuper-Szablewska
- Department of Chemistry, Faculty of Forestry and Wood Technology, Poznań University of Life Sciences, Poznań, Poland
| | - J. Markowska
- Frozen Food Technology and Refrigeration Department, Prof. Wacław Dąbrowski Institute of Agricultural and Food Biotechnology - State Research Institute, Lodz, Poland
| | - P. Szulc
- Department of Agronomy, Faculty of Agronomy, Horticulture and Bioengineering, Poznań University of Life Sciences, Poznań, Poland
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Abstract
OBJECTIVES Assessment of the progression of abdominal aortic calcification (AAC) may be a surrogate marker of the impact of physical function on cardiovascular risk. Our aim was to assess the risk of rapid AAC progression in older men with low relative appendicular lean mass (RALM) and poor physical function. DESIGN Prospective cohort study. SETTING Community-dwelling older men. PARTICIPANTS 621 men aged 50-85 followed prospectively (baseline, 3 and 7.5 years). MEASUREMENTS Body composition was assessed by DXA. Poor physical function was defined as incapacity to perform ≥1 of 5 clinical tests (balance, muscle strength). AAC was assessed using Kauppila's semiquantitative score. Reclassification improvement was assessed by comparing the areas under the curve (AUC) using DeLong's method. RESULTS Rapid AAC progression (>0.6 point/year) was found in 168 men (27.1%). After adjustment for confounders including baseline AAC, the risk of rapid AAC progression increased with lower RALM (OR=1.42/SD, 95%CI: 1.09-1.86, p<0.01) and was higher in the lowest (<7.5kg/m2) vs. highest (>8.6kg/m2) quartile (OR=2.15, 95%CI: 1.17-3.95, p<0.01). Poor physical performance was associated with rapid AAC progression (OR=2.76, 95%CI: 1.48-5.91, p<0.005). Low RALM (<7.84kg/m2 defined using Youden's index) and poor physical function contributed to the risk of rapid AAC progression jointly. Men who had low RALM and poor physical function had higher risk of rapid AAC progression vs. men without these traits (OR=4.66, 95%CI: 1.72-12.62, p<0.05). RALM and physical function improved the identification of men with rapid AAC progression (DAUC=0.026, 95%CI: 0.005-0.046, p<0.05) after adjustment for confounders including baseline AAC score. CONCLUSIONS Low RALM and poor physical function are associated with higher risk of rapid AAC progression and possibly represent another measure of cardiovascular risk.
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Affiliation(s)
- P Szulc
- Pawel Szulc, MD PhD, INSERM UMR 1033, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon, France,
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Abstract
BACKGROUND Hormonal disorders are often associated with abnormal levels of bone turnover markers (BTMs). N-terminal propeptide of type I procollagen (PINP) and serum C-terminal cross-linking telopeptide of type I collagen (CTX-I) are the reference markers of bone formation and bone resorption, respectively. METHODS A comprehensive literature search within the MEDLINE and Web of Science databases was performed. RESULTS Acromegaly is associated with higher BTM levels, which decrease during the remission after treatment. Adult-onset growth hormone deficiency is often associated with decreased BTM levels. Growth hormone replacement therapy stimulates bone turnover and increases BTM levels. Hypothyroidism is characterized by general slowing of bone metabolism which is reflected by lower BTM levels. The replacement thyroid hormone therapy increases the bone turnover rate and BTM levels increase. Patients with thyroid cancer receive a suppressive dose of thyroid hormones and may have slightly elevated BTM levels. Patients with overt hyperthyroidism had higher BTM levels and anti-thyroid therapy induces a rapid decrease in the BTM levels. Patients with overt primary hyperparathyroidism have higher BTM levels, whereas those with asymptomatic and normocalcemic hyperparathyroidism usually have normal BTM levels. Hypoparathyroidism is characterized by slightly decreased BTM levels. Cushing's syndrome is characterized consistently by markedly decreased osteocalcin concentration, whereas data on other BTMs are discordant. CONCLUSIONS BTMs help us to better understand mechanisms of the impact of hormonal disorders and their treatment on bone metabolism. However, it is unknown whether BTMs may be used to monitor the effect of their treatments on bone in the clinical practice.
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Affiliation(s)
- P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France.
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Paccou J, Bavière W, Chapurlat R, Sornay-Rendu E, Szulc P, Cortet B, Flipo RM. AB0815 CHANGES IN BODY COMPOSITION, BONE MINERAL DENSITY AND BONE REMODELING MARKERS DURING INTERLEUKIN 12/23 INHIBITION IN PSORIATIC ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by multiple comorbid conditions including cardiovascular comorbidities, diabetes, obesity and osteoporosis. Little is known about body composition in patients with PsA and no data are available regarding body composition changes under DMARDs.Objectives:We investigated the effects of ustekinumab (UST), a humanized anti-interleukin 12/23 antibody, on body composition, bone mineral density (BMD) and bone remodeling markers in patients treated for PsA.Methods:Thirty patients with active PsA treated with UST were included in a 6 months open follow-up study. Body mass index, DAS28-CRP, bone remodeling markers, serum levels of leptin, BMD and body composition (dual-energy X-ray absorptiometry) were measured at baseline and 6 months of treatment. At baseline, PsA patients were compared with 60 non-PsA controls matched for age, sex and body mass index.Results:Compared with controls, we observed lower total and appendicular lean mass (53.1 ±13.1 vs. 56.7 ±11.9 kg, p=0.013 and 21.6 ±6.3 vs. 23.4 ±5.0 kg, p=0.010 respectively) and greater fat mass in PsA (32.5 ±10.8 vs. 25.2 ±8.9 kg, p<0.001). Among PsA patients, 30% had a skeletal muscle mass index below the cut-off point for sarcopenia (Baumgartner’s criteria: men 7.26 kg/m2, women 5.5 kg/m2) whereas no case was observed in the control group. After 6 months of treatment with UST, there was not a significant change of BMI, while there was a tendency for reaching the significant level for fat mass (+1.75 ±3.60 kg, p=0.054), and fat mass index (+0.59 ±1.25 kg/m2, p=0.061). In contrast, a decrease in total lean mass was observed (-1.57 ±3.10 kg, p=0.046) without a significant change in appendicular lean mass and skeletal muscle mass index. No changes for bone remodeling markers, leptin and BMD were observed at 6 months.Conclusion:Patients with active PsA required biologic therapy had increased fat mass and decreased lean mass. Moreover, ustekinumab might worsen the decrease in lean mass with no significant change in fat mass.Disclosure of Interests:Julien Paccou Grant/research support from: Janssen, Speakers bureau: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, Sanofi, UCB, Wallis Bavière: None declared, Roland Chapurlat: None declared, Elisabeth Sornay-Rendu: None declared, Pawel Szulc: None declared, Bernard Cortet Consultant of: Aptissen, René-Marc Flipo Consultant of: Johnson and Johnson, MSD France, Novartis, Sanofi, Speakers bureau: Johnson and Johnson, MSD France, Novartis, Sanofi
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Leow K, Szulc P, Schousboe J, Kiel D, Teixeira-Pinto A, Shaikh H, Sawang M, Bondonno N, Hodgson J, Sharma A, Thompson P, Prince R, Craig J, Lim W, Wong G, Lewis J. Prognostic Value of Abdominal Aortic Calcification: A Systematic Review and Meta-analysis of Observational Studies. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hugues A, Di-Marco J, Janiaud P, Xue Y, Zhu J, Pires J, Khademi H, Rubio L, Hernandez Bernal P, Bahar Y, Charvat H, Szulc P, Ciumas C, Won H, Cucherat M, Bonan I, Gueyffier F, Rode G. Effects of physical therapy on postural imbalance depending on time since stroke: A meta-analysis. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Szulc P, Naylor K, Hoyle NR, Eastell R, Leary ET. Use of CTX-I and PINP as bone turnover markers: National Bone Health Alliance recommendations to standardize sample handling and patient preparation to reduce pre-analytical variability. Osteoporos Int 2017. [PMID: 28631236 DOI: 10.1007/s00198-017-4082-4] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED The National Bone Health Alliance (NBHA) recommends standardized sample handling and patient preparation for C-terminal telopeptide of type I collagen (CTX-I) and N-terminal propeptide of type I procollagen (PINP) measurements to reduce pre-analytical variability. Controllable and uncontrollable patient-related factors are reviewed to facilitate interpretation and minimize pre-analytical variability. INTRODUCTION The IOF and the International Federation of Clinical Chemistry (IFCC) Bone Marker Standards Working Group have identified PINP and CTX-I in blood to be the reference markers of bone turnover for the fracture risk prediction and monitoring of osteoporosis treatment. Although used in clinical research for many years, bone turnover markers (BTM) have not been widely adopted in clinical practice primarily due to their poor within-subject and between-lab reproducibility. The NBHA Bone Turnover Marker Project team aim to reduce pre-analytical variability of CTX-I and PINP measurements through standardized sample handling and patient preparation. METHODS Recommendations for sample handling and patient preparations were made based on review of available publications and pragmatic considerations to reduce pre-analytical variability. Controllable and un-controllable patient-related factors were reviewed to facilitate interpretation and sample collection. RESULTS Samples for CTX-I must be collected consistently in the morning hours in the fasted state. EDTA plasma is preferred for CTX-I for its greater sample stability. Sample collection conditions for PINP are less critical as PINP has minimal circadian variability and is not affected by food intake. Sample stability limits should be observed. The uncontrollable aspects (age, sex, pregnancy, immobility, recent fracture, co-morbidities, anti-osteoporotic drugs, other medications) should be considered in BTM interpretation. CONCLUSION Adopting standardized sample handling and patient preparation procedures will significantly reduce controllable pre-analytical variability. The successful adoption of such recommendations necessitates the close collaboration of various stakeholders at the global stage, including the laboratories, the medical community, the reagent manufacturers and the regulatory agencies.
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Affiliation(s)
- P Szulc
- INSERM UMR 1033, Hôpital Edouard Herriot, University of Lyon, Pavillon F, Place d'Arsonval, 69437, Lyon, France.
| | - K Naylor
- Academic Unit of Bone Metabolism and Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | | | - R Eastell
- Academic Unit of Bone Metabolism and Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - E T Leary
- ETL Consulting, Seattle, WA, 98177, USA
- Pacific Biomarkers, Seattle, WA, 98119, USA
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Confavreux CB, Casey R, Varennes A, Goudable J, Chapurlat RD, Szulc P. Has sclerostin a true endocrine metabolic action complementary to osteocalcin in older men? Osteoporos Int 2016; 27:2301-2309. [PMID: 27007475 DOI: 10.1007/s00198-016-3540-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/11/2016] [Indexed: 01/27/2023]
Abstract
UNLABELLED The reported association between sclerostin and diabetes mellitus or abdominal fat may be biased by body size and bone mass. In older men, the association between serum sclerostin levels and metabolic syndrome lost significance after adjustment for bone mass. The association between sclerostin and energy metabolism needs further clarification. INTRODUCTION Sclerostin is associated with abdominal fat, but this relationship may be biased since both are associated with body size and bone mass. Osteocalcin is a bone-derived hormone regulating energy metabolism. We assessed the association between serum sclerostin and metabolic syndrome (MetS) accounting for whole body mineral content (BMC) and osteocalcin. METHODS We studied 694 men aged 51-85 who had serum osteocalcin and sclerostin measurements. RESULTS Sclerostin was higher in 216 men with MetS compared with those without MetS (p < 0.005). Average sclerostin level increased significantly across the increasing number of MetS components. In multivariable models, higher sclerostin was associated with higher odds of MetS (odds ratio (OR) = 1.24/1 standard deviation (SD) increase [95 % confidence interval (95 % CI), 1.01-1.51]; p < 0.05). After further adjustment for BMC, the association of MetS with sclerostin lost significance, whereas that with osteocalcin remained significant. Men who were simultaneously in the highest sclerostin quartile and the lowest osteocalcin quartile had higher odds of MetS (OR = 2.14 [95 % CI, 1.15-4.18]; p < 0.05) vs. men being in the three lower sclerostin quartiles and three upper osteocalcin quartiles. After adjustment for whole body BMC, the association lost significance. CONCLUSIONS Higher sclerostin level is associated with MetS severity; however, this association may be related to higher whole body BMC. The adjustment for BMC had no impact on the association between MetS and osteocalcin. Clinical cross-sectional studies do not elucidate the potential role of sclerostin in the regulation of energy metabolism and direct experimental approach is necessary.
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Affiliation(s)
- C B Confavreux
- INSERM UMR1033 - Université de Lyon, Department of Rheumatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, 69003, France.
| | - R Casey
- OFSEP-Université de Lyon, Hospices Civils de Lyon, Lyon, 69003, France
| | - A Varennes
- Université de Lyon, Central Biochemical Laboratory, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, 69003, France
| | - J Goudable
- INSERM UMR1060 - Université de Lyon, Lyon, France
| | - R D Chapurlat
- INSERM UMR1033 - Université de Lyon, Department of Rheumatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, 69003, France
| | - P Szulc
- INSERM UMR1033 - Université de Lyon, Department of Rheumatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, 69003, France
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Waszak MM, Cieślik K, Lewandowski J, Boch-Kmieciak J, Szulc P, Bręborowicz G. Porównanie biometrycznych parametrów urodzeniowych noworodków z ciąży bliźniaczej pochodzących ze środowiska wiejskiego i miejskiego w Wielkopolsce. Ginekol Pol 2016; 87:124-30. [PMID: 27306289 DOI: 10.17772/gp/61550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Indexed: 11/12/2022] Open
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El-Sherbiny M, Cieślak A, Szczechowiak J, Kołodziejski P, Szulc P, Szumacher-Strabel M. Effect of nanoemulsified oils addition on rumen fermentation and fatty acid proportion in a rumen simulation technique. J Anim Feed Sci 2016. [DOI: 10.22358/jafs/65571/2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Szulc P, Waszak M, Bartkowiak M, Bartkowiak P, Tomczak M, Boch-Kmieciak J, Cieślik K. Distribution of plantar pressure during jogging barefoot or in minimalistic shoes in people who used to run in cushioned shoes. J Sports Med Phys Fitness 2016; 57:565-571. [PMID: 26955905 DOI: 10.23736/s0022-4707.16.06183-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In recent years, an increasing number of runners prefer jogging barefoot or in minimalistic shoes. The aim of this study was to compare the distribution of plantar pressure during jogging barefoot, in minimalistic shoes, or in shoes with cushioned soles, as these forces modulate the risk of injury. METHODS The study included nine men aged between 24 and 25 years, who engaged in long-distance running. The plantar pressure of three foot zones (forefoot, midfoot, and hindfoot) was examined with WIN-POD electronic podometer during running barefoot, in minimalistic shoes, or in shoes with cushioned soles. RESULTS Individuals who ran barefoot showed the greatest forefoot pressure, followed by those running in minimalistic shoes and cushioned shoes. In contrast, the heel pressure in individuals running in cushioned shoes was significantly greater than in those using minimalistic shoes or running barefoot. CONCLUSIONS Switching from running in cushioned shoes to jogging barefoot is associated with the accumulation of greatest pressure in the forefoot and midfoot. The accumulation of the greatest pressure at the insertion of plantar aponeurosis can lead to the injuries of musculoskeletal system, in particular plantar aponeurositis. Even distribution of pressure among various parts of the foot in persons running in minimalistic shoes is associated with lower risk of injury than in the case of running barefoot.
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Affiliation(s)
- Paweł Szulc
- Department of Functional Anatomy, University School of Physical Education, Poznan, Poland
| | - Małgorzata Waszak
- Department of Functional Anatomy, University School of Physical Education, Poznan, Poland -
| | - Michał Bartkowiak
- Department of Functional Anatomy, University School of Physical Education, Poznan, Poland
| | - Piotr Bartkowiak
- Department of Functional Anatomy, University School of Physical Education, Poznan, Poland
| | - Maciej Tomczak
- Department of Sport Psychology, University School of Physical Education, Poznan, Poland
| | - Joanna Boch-Kmieciak
- Department of Functional Anatomy, University School of Physical Education, Poznan, Poland
| | - Krystyna Cieślik
- Department of Functional Anatomy, University School of Physical Education, Poznan, Poland
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Breuil V, Fontas E, Chapurlat R, Panaia-Ferrari P, Yahia HB, Faure S, Euller-Ziegler L, Amri EZ, Szulc P. Oxytocin and bone status in men: analysis of the MINOS cohort. Osteoporos Int 2015; 26:2877-82. [PMID: 26109496 DOI: 10.1007/s00198-015-3201-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/08/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED Oxytocin, a neurohypophysial hormone, regulates bone metabolism in animal studies and postmenopausal women. In men, oxytocin is not associated with bone mineral density, bone turnover markers, or prevalent fractures, but weakly negatively with incident fragility fracture requiring further studies. INTRODUCTION We previously showed that serum oxytocin (OT) level is associated with bone mineral density (BMD) and bone turnover rate in postmenopausal women. The aim of our study was to assess the relationship between circulating OT levels and bone status in men. METHODS In 552 men aged 50 and older from the MINOS cohort, we measured serum levels of OT. We assessed the association of serum OT levels with BMD (lumbar, femoral neck, total hip), bone turnover markers (BTM) (serum N-terminal propeptide of type I procollagen (PINP), bone-specific alkaline phosphatase (bone ALP), and C-terminal telopeptide of type I collagen (CTX-I)) and fracture risk. RESULTS In the univariate analysis, serum OT level was not associated with BMD at any site, BTM levels, or with prevalent or incident fracture. OT was significantly correlated with body mass index (BMI) (r = 0.17, p < 0.001), total or bioavalaible 17β-estradiol (r = 0.09, p = 0.04 and r = 0.20, p < 0.001, respectively), free testosterone (r = 0.17, p < 0.001), and leptin (r = 0.16, p < 0.001). Multivariate analysis did not show significant relationship between serum OT and BMD. After adjustment for age, BMI, interaction BMI/age, history of fall in the last year, and BMD, OT and prevalent fracture were not associated. By contrast, the same analysis with additional adjustment for prevalent fracture showed a weakly significant negative association between OT and incident fracture, e.g., after adjustment for femoral neck BMD, HR = 0.73, 95 %CI 0.55-0.99, p = 0.04. CONCLUSION In men, serum OT levels are not associated with BMD, bone turnover rate, or prevalent fractures. The weak negative relationship with fracture risk requires further studies.
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Affiliation(s)
- V Breuil
- Nice University Hospital, Pasteur Hospital, Department of Rheumatology, Nice, F-06003, France.
- UMR E-4320 MATOs CEA/iBEB/SBTN, Université Nice Sophia Antipolis, Faculté de Médecine, Nice, France.
| | - E Fontas
- Nice University Hospital, Cimiez Hospital, Department of Clinical Research, Nice, F-06003, France
| | - R Chapurlat
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Lyon, France
| | - P Panaia-Ferrari
- Nice University Hospital, Saint Roch Hospital, Department of Hormonology, Nice, F-06003, France
| | - H B Yahia
- Nice University Hospital, Saint Roch Hospital, Department of Hormonology, Nice, F-06003, France
- CNRS, iBV UMR 7277, 06100, Nice, France
- Inserm, iBV, U1091, 06100, Nice, France
| | - S Faure
- Nice University Hospital, Saint Roch Hospital, Department of Hormonology, Nice, F-06003, France
| | - L Euller-Ziegler
- Nice University Hospital, Pasteur Hospital, Department of Rheumatology, Nice, F-06003, France
| | - E Z Amri
- CNRS, iBV UMR 7277, 06100, Nice, France
- Inserm, iBV, U1091, 06100, Nice, France
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Lyon, France
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Szulc P, Wendt M, Waszak M, Tomczak M, Cieślik K, Trzaska T. Impact of McKenzie Method Therapy Enriched by Muscular Energy Techniques on Subjective and Objective Parameters Related to Spine Function in Patients with Chronic Low Back Pain. Med Sci Monit 2015; 21:2918-32. [PMID: 26418868 PMCID: PMC4596425 DOI: 10.12659/msm.894261] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The high incidence and inconsistencies in diagnostic and therapeutic process of low back pain (LBP) stimulate the continuing search for more efficient treatment modalities. Integration of the information obtained with various therapeutic methods and a holistic approach to the patient seem to be associated with positive outcomes. The aim of this study was to analyze the efficacy of combined treatment with McKenzie method and Muscle Energy Technique (MET), and to compare it with the outcomes of treatment with McKenzie method or standard physiotherapy in specific chronic lumbar pain. Material/Methods The study included 60 men and women with LBP (mean age 44 years). The patients were randomly assigned to 1 of 3 therapeutic groups, which were further treated with: 1) McKenzie method and MET, 2) McKenzie method alone, or 3) standard physiotherapy for 10 days. The extent of spinal movements (electrogoniometry), level of experienced pain (Visual Analogue Scale and Revised Oswestry Pain Questionnaire), and structure of the spinal discs (MRI) were examined prior to the intervention, immediately thereafter, and 3 months after the intervention. Results McKenzie method enriched with MET had the best therapeutic outcomes. The mobility of cervical, thoracic, and lumbar spine normalized at levels corresponding to 87.1%, 66.7%, and 95% of respective average normative values. Implementation of McKenzie method, both alone and combined with MET, was associated with a significant decrease in Oswestry Disability Index, significant alleviation of pain (VAS), and significantly reduced size of spinal disc herniation. Conclusions The combined method can be effectively used in the treatment of chronic LBP.
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Affiliation(s)
- Paweł Szulc
- Department of Functional Anatomy, University School of Physical Education, Poznań, Poland
| | - Michał Wendt
- Department of Sports Medicine and Traumatology, University School of Physical Education, Poznań, Poland
| | - Małgorzata Waszak
- Department of Functional Anatomy, University School of Physical Education, Poznań, Poland
| | - Maciej Tomczak
- Department of Psychology, University School of Physical Education, Poznań, Poland
| | - Krystyna Cieślik
- Department of Functional Anatomy, University School of Physical Education, Poznań, Poland
| | - Tadeusz Trzaska
- Department of Sports Medicine and Traumatology, University School of Physical Education, Poznań, Poland
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Nagy H, Chapurlat R, Sornay-Rendu E, Boutroy S, Szulc P. Family resemblance of bone turnover rate in mothers and daughters--the MODAM study. Osteoporos Int 2015; 26:921-30. [PMID: 25524020 DOI: 10.1007/s00198-014-2974-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/17/2014] [Indexed: 01/08/2023]
Abstract
UNLABELLED We studied bone turnover markers (BTM) and bone microarchitecture (using high-resolution peripheral quantitative computed tomography (HR-pQCT)) in 171 postmenopausal women and their 210 premenopausal daughters. BTM levels correlated positively between mothers and daughters. The mother-daughter pairs with high BTM levels had lower cortical density than those with low BTM levels. INTRODUCTION We assessed the correlation of serum bone turnover markers (BTM) between postmenopausal mothers and their premenopausal daughters as well as possible determinants of this association and its impact on resemblance of bone microarchitecture between mothers and their daughters. METHODS Cross-sectional analysis was performed in 171 untreated postmenopausal mothers (54 sustained fragility fractures) and their 210 premenopausal daughters. Intact N-terminal propeptide of type I collagen (PINP) and β-isomerized C-terminal crosslinking telopeptide of type I collagen (CTX-I) were measured in the fasting status. Bone microarchitecture was assessed using HR-pQCT. RESULTS After adjustment for age, weight, lifestyle factors, hormones, and mother's fracture status, BTM levels correlated positively between mothers and daughters (Intraclass Correlation Coefficient = 0.22-0.27, p <0.005). Average BTM levels were ∼ 0.6 SD higher among daughters of mothers in the highest BTM quartile vs. the ones in the lowest BTM quartile. The variability of BTM levels explained ≤ 10 and ≤ 14% of variability of bone microarchitecture in the daughters and mothers, respectively. Cortical density was lower by 2.3-2.9% (0.6 SD, p <0.05 to <0.005) in the daughters from the mother-daughter pairs with high BTM levels (defined by generation-specific quartiles) than in the daughters from the pairs with low BTM levels. Corresponding differences for the mothers were 4.5-4.8% (0.5 SD, p <0.05 to <0.01). CONCLUSION BTM levels correlated between postmenopausal mothers and their premenopausal daughters after adjustment for age, weight, mother's fracture status, lifestyle, and hormonal factors. Family resemblance of BTM levels may contribute to family resemblance of some bone microarchitectural parameters, especially of cortical density.
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Affiliation(s)
- H Nagy
- INSERM UMR 1033, Université de Lyon, Hôpital Édouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France
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Czechowski T, Chlewicki W, Baranowski M, Jurga K, Szczepanik P, Szulc P, Tadyszak K, Kedzia P, Szostak M, Malinowski P, Wosinski S, Prukala W, Jurga J. Two-dimensional EPR imaging with the rapid scan and rotated magnetic field gradient. J Magn Reson 2014; 248:126-30. [PMID: 25442781 DOI: 10.1016/j.jmr.2014.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/13/2014] [Accepted: 09/23/2014] [Indexed: 05/12/2023]
Abstract
A new method for fast 2D Electron Paramagnetic Resonance Imaging (EPRI) is presented. To reduce the time of projections acquisition we propose to combine rapid scan of Zeeman magnetic field using high frequency sinusoidal modulation with simultaneously applied magnetic field gradient, whose orientation is changed at low frequency. The correctness of the method is confirmed by studies carried out on a phantom consisting of two LiPc samples. The images from the acquired data are reconstructed using iterative algorithms. The proposed method allows to reduce the image acquisition time up to 10 ms for 2D EPRI, and to detect the sinogram with infinitesimal angular step between projections.
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Affiliation(s)
- T Czechowski
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland.
| | - W Chlewicki
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland; Faculty of Electrical Engineering, West Pomeranian University of Technology, 70-310 Szczecin, Poland
| | - M Baranowski
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland; Department of Physics, Adam Mickiewicz University, 61-614 Poznan, Poland
| | - K Jurga
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - P Szczepanik
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - P Szulc
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - K Tadyszak
- NanoBioMedical Centre, Adam Mickiewicz University, ul. Umultowska 14, PL 61614 Poznan, Poland
| | - P Kedzia
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - M Szostak
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - P Malinowski
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - S Wosinski
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - W Prukala
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland; Department of Organometalic Chemistry, Adam Mickiewicz University, 60-780 Poznan, Poland
| | - J Jurga
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
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Grześkowiak M, Szulc P, Szwedziak M, Lewandowski J. The effect of the Kinesio Taping method on spinal motion and physiological spinal curvatures. Literature review. Ortop Traumatol Rehabil 2014; 16:221-6. [PMID: 25041892 DOI: 10.5604/15093492.1105247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Kinesiology Taping / Kinesio Taping (KT) method has become more and more popular in recent years. Many studies have been developed to demonstrate the application of this method in numerous fields of medicine. Despite its continuous development, several issues pertaining to the legitimacy of its application and mechanisms of its operation still need to be addressed. The aim of this study is to analyse the available literature in terms of the effect of KT on the spinal motion and physiological spinal curvatures. This study is based on a method of analysing bibliographic databases such as: SPORTDiscus, Medline, ScienceDirect, EBSCOhost, and Google Scholar. RESULTS AND CONCLUSIONS There were found seven research articles that observe the criteria of this study's aim. Four of those research articles were devoted to the motion of the lumbar spinal segment, the other two discussed the motion of the cervical spinal segment and one of them concentrated on the lumbar lordosis. None of those research articles included any information on negative effect of this method. The effect of KT on assessed parameters is barely noticeable. Therefore, it is necessary to conduct further research in respect of the effect of the Kinesiology Taping method on the spinal motion and physiological spinal curvatures.
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Affiliation(s)
- Marcin Grześkowiak
- Chair of Rehabilitation of Internal Diseases, University School of Physical Education in Poznań, Poland
| | - Paweł Szulc
- Chair of Anatomy, University School of Physical Education in Poznań, Poland
| | - Marek Szwedziak
- Chair of Rehabilitation of Motor Organ, University School of Physical Education in Poznań, Poland
| | - Jacek Lewandowski
- Chair of Rehabilitation of Motor Organ, University School of Physical Education in Poznań, Poland
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Czechowski T, Chlewicki W, Baranowski M, Jurga K, Szczepanik P, Szulc P, Kedzia P, Szostak M, Malinowski P, Wosinski S, Prukala W, Jurga J. Two-dimensional spectral-spatial EPR imaging with the rapid scan and modulated magnetic field gradient. J Magn Reson 2014; 243:1-7. [PMID: 24705409 DOI: 10.1016/j.jmr.2014.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 06/03/2023]
Abstract
A new method for fast spectral-spatial electron paramagnetic resonance imaging (EPRI) is presented. To reduce the time of projections acquisition we propose to combine rapid scan of Zeeman magnetic field using high frequency sinusoidal modulation with simultaneously applied magnetic field gradients, whose amplitude is modulated at low frequency. The correctness of the method is confirmed by studies carried out on a phantom consisting of two LiPc samples. The spectral-spatial images from the acquired data are reconstructed using iterative algorithms. The proposed method allows to acquire the spectral-spatial image with 800 projections at 200ms.
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Affiliation(s)
- T Czechowski
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland.
| | - W Chlewicki
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland; Faculty of Electrical Engineering, West Pomeranian University of Technology, 70-310 Szczecin, Poland
| | - M Baranowski
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland; Department of Physics, Adam Mickiewicz University, 61-614 Poznan, Poland
| | - K Jurga
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - P Szczepanik
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - P Szulc
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - P Kedzia
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - M Szostak
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - P Malinowski
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - S Wosinski
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
| | - W Prukala
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland; Department of Organometallic Chemistry, Adam Mickiewicz University, 60-780 Poznan, Poland
| | - J Jurga
- Laboratory of EPR Tomography, Poznan University of Technology, 60-965 Poznan, Poland
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Szulc P, Estublier C, Bertholon C, Marchand F, Chapurlat R. SAT0440 Serum Sclerostin is Higher in Men with Severe Osteophytes at the Spine – the Minos Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Szulc P, Schoppet M, Rachner TD, Chapurlat R, Hofbauer LC. Severe abdominal aortic calcification in older men is negatively associated with DKK1 serum levels: the STRAMBO study. J Clin Endocrinol Metab 2014; 99:617-24. [PMID: 24276456 DOI: 10.1210/jc.2013-3201] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Experimental data show that dickkopf-1 (DKK1) may be involved in the regulation of arterial calcification. However, clinical data on the association between serum DKK1 levels and severity of abdominal aortic calcification (AAC) are scarce. OBJECTIVE Our aim was to determine the association between serum DKK1 concentration and AAC severity in men. DESIGN This is a cross-sectional analysis in the STRAMBO cohort. SETTING The cohort was recruited from the general population. PARTICIPANTS We examined 1139 male volunteers aged 20 to 87 years. No specific exclusion criteria were used. INTERVENTIONS We collected blood samples and assessed AAC severity on the lateral spine scans obtained by a Discovery A Hologic device using the semiquantitative Kauppila score. MAIN OUTCOME MEASURES We tested the hypothesis that low DKK1 levels are associated with AAC severity in men. RESULTS In men aged 20 to 60 years, serum DKK1 levels were not associated with other variables. In men aged 60 years and older, lower DKK1 levels were associated with higher odds of severe AAC (AAC score >5). After adjustment for confounders, odds of severe AAC increased with decreasing DKK1 levels (odds ratio = 1.42, 95% confidence interval = 1.13-1.79, P < .005) and was higher below vs above the median DKK1 level (odds ratio = 2.19, 95% confidence interval = 1.37-3.49, P < .005). Heavy smoking, hypertension, ischemic heart disease, and elevated levels of fibroblast growth factor 23 were associated with severe AAC significantly, independently of DKK1 and additively with low DKK1 levels. CONCLUSION In older men, lower serum DKK1 levels are associated with severe AAC regardless of age and other potential confounders.
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Affiliation(s)
- P Szulc
- Inserm Unité Mixte de Recherche 1033 (P.S., R.C.), University of Lyon, Hospices Civils de Lyon, F-69437 Lyon, France; Department of Internal Medicine and Cardiology (M.S.), Philipps-University, D-35043 Marburg, Germany; Division of Endocrinology, Diabetes, and Bone Diseases (T.D.R., L.C.H.), Dresden University Medical Center, Dresden, Germany; and Center for Regenerative Therapies (L.C.H.), D-01307 Dresden, Germany
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26
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Kanis JA, Adachi JD, Cooper C, Clark P, Cummings SR, Diaz-Curiel M, Harvey N, Hiligsmann M, Papaioannou A, Pierroz DD, Silverman SL, Szulc P. Standardising the descriptive epidemiology of osteoporosis: recommendations from the Epidemiology and Quality of Life Working Group of IOF. Osteoporos Int 2013; 24:2763-4. [PMID: 23884436 PMCID: PMC5096926 DOI: 10.1007/s00198-013-2413-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The Committee of Scientific Advisors of International Osteoporosis Foundation (IOF) recommends that papers describing the descriptive epidemiology of osteoporosis using bone mineral density (BMD) at the femoral neck include T-scores derived from an international reference standard. INTRODUCTION The prevalence of osteoporosis as defined by the T-score is inconsistently reported in the literature which makes comparisons between studies problematic. METHODS The Epidemiology and Quality of Life Working Group of IOF convened to make its recommendations and endorsement sought thereafter from the Committee of Scientific Advisors of IOF. RESULTS The Committee of Scientific Advisors of IOF recommends that papers describing the descriptive epidemiology of osteoporosis using BMD at the femoral neck include T-scores derived from the National Health and Nutrition Examination Survey III reference database for femoral neck measurements in Caucasian women aged 20-29 years. CONCLUSIONS It is expected that the use of the reference standard will help resolve difficulties in the comparison of results between studies and the comparative assessment of new technologies.
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Affiliation(s)
- J A Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK,
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Nagy H, Sornay-Rendu E, Boutroy S, Vilayphiou N, Szulc P, Chapurlat R. Impaired trabecular and cortical microarchitecture in daughters of women with osteoporotic fracture: the MODAM study. Osteoporos Int 2013. [PMID: 23179577 DOI: 10.1007/s00198-012-2223-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED We investigated the familial resemblance of bone microarchitecture parameters between postmenopausal mothers with fragility fracture and their premenopausal daughters using high-resolution peripheral quantitative computed tomography (HR-pQCT). We found that daughters of women with fracture have lower total volumetric bone mineral density (vBMD), thinner cortices, and impaired trabecular microarchitecture at the distal radius and tibia, compared to controls. INTRODUCTION Familial resemblance of areal bone mineral density (aBMD) in mothers and daughters has been widely studied, but not its morphological basis, including microarchitecture. METHODS We compared aBMD, vBMD, bone size, and bone microarchitecture at the distal radius and tibia assessed by HR-pQCT in mothers and their premenopausal daughters. We included 115 women aged 43 ± 8 years whose mothers had sustained a fragility fracture and 206 women aged 39 ± 9 years whose mothers had never sustained a fragility fracture. RESULTS Women whose mothers had fracture had significantly (p < 0.05) lower aBMD at the lumbar spine, total hip, femoral neck, mid-distal radius, and ultradistal radius compared to controls. In similar multivariable models, women whose mothers had a fracture had lower total vBMD at the distal radius (-5 %, 0.3 standard deviation [SD]; p < 0.005) and distal tibia (-7 %, 0.4 SD; p < 0.005). They also had lower cortical thickness and area at the distal radius (-5 %, 0.3 SD and -4 %, 0.2 SD, respectively; p < 0.005) and at the distal tibia (-6 %, 0.3 SD and -4 %, 0.3SD, respectively; p < 0.005). Trabecular vBMD was lower at the distal radius (-5 %, 0.3 SD; p < 0.05) and tibia (-8 %, 0.4 SD; p < 0.005), with a more spaced and heterogeneous trabecular network (4 and 7 % at the radius and 5 and 9 %, at the tibia, p < 0.05, for Tb.Sp and Tb.Sp.SD, respectively). CONCLUSION Premenopausal daughters of women who had sustained fragility fracture have lower total and trabecular vBMD, thinner cortices, as well as impaired trabecular microarchitecture at the distal radius and tibia, compared with premenopausal daughters of women without fracture.
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Affiliation(s)
- H Nagy
- INSERM UMR 1033, Université de Lyon, Hôpital E. Herriot, Pavillon F, 69437 Lyon Cedex 03, France.
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Szulc P, Samelson EJ, Sornay-Rendu E, Chapurlat R, Kiel DP. Severity of aortic calcification is positively associated with vertebral fracture in older men--a densitometry study in the STRAMBO cohort. Osteoporos Int 2013; 24:1177-84. [PMID: 22872071 PMCID: PMC3656471 DOI: 10.1007/s00198-012-2101-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 07/20/2012] [Indexed: 01/13/2023]
Abstract
UNLABELLED In older men, severe abdominal aortic calcification and vertebral fracture (both assessed using dual-energy X-ray absorptiometry) were positively associated after adjustment for confounders including bone mineral density. INTRODUCTION Abdominal aortic calcification (AAC) is associated with higher fracture risk, independently of low bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) can be used to assess both vertebral fracture and AAC and requires less time, cost, and radiation exposure. METHODS We conducted a cross-sectional study of the association between AAC and prevalent vertebral fractures in 901 men≥50 years old. We used DXA (vertebral fracture assessment) to evaluate BMD, vertebral fracture, and AAC. RESULTS Prevalence of vertebral fracture was 11%. Median AAC score was 1 and 12% of men had AAC score>6. After adjustment for age, weight, femoral neck BMD, smoking, ischemic heart disease, diabetes, and hypertension, AAC score>6 (vs ≤6) was associated with 2.5 (95% CI, 1.4-4.5) higher odds of vertebral fracture. Odds of vertebral fracture for AAC score>6 increased with vertebral fracture severity (grade 1, OR=1.8; grade 2, OR=2.4; grade 3, OR=4.4; trend p<0.01) and with the number of vertebral fractures (1 fracture, OR=2.0, >1 fracture, OR=3.5). Prevalence of vertebral fracture was twice as high in men having both a T-score<-2.0 and an AAC score>6 compared with men having only one of these characteristics. CONCLUSIONS Men with greater severity AAC had greater severity and greater number of vertebral fractures, independently of BMD and co-morbidities. DXA can be used to assess vertebral fracture and AAC. It can provide a rapid, safe, and less expensive alternative to radiography. DXA may be an important clinical tool to identify men at high risk of adverse outcomes from osteoporosis and cardiovascular disease.
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Affiliation(s)
- P Szulc
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Lyon, France.
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Verschueren S, Gielen E, O'Neill TW, Pye SR, Adams JE, Ward KA, Wu FC, Szulc P, Laurent M, Claessens F, Vanderschueren D, Boonen S. Sarcopenia and its relationship with bone mineral density in middle-aged and elderly European men. Osteoporos Int 2013; 24:87-98. [PMID: 22776861 DOI: 10.1007/s00198-012-2057-z] [Citation(s) in RCA: 200] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/12/2012] [Indexed: 11/29/2022]
Abstract
UNLABELLED The aim of this study was to determine the relationship between reduced muscle mass (sarcopenia) and areal bone mineral density (BMD(a)) in middle-aged and elderly community-dwelling European men. Men with sarcopenia had significantly lower BMD(a) and were more likely to have osteoporosis compared with men without sarcopenia. INTRODUCTION In men, the relationship between reduced muscle mass (sarcopenia) and BMD(a) is unclear. This study aimed to determine this relationship in middle-aged and elderly community-dwelling men. METHODS Men aged 40-79 years from the Manchester (UK) and Leuven (Belgium) cohorts of the European Male Ageing Study were invited to attend for assessment including dual-energy X-ray absorptiometry, from which appendicular lean mass (aLM), fat mass (FM) and whole-body, spine and hip BMD(a) were determined. Relative appendicular skeletal muscle mass (RASM) was calculated as aLM/height². Muscle strength was assessed in subjects from Leuven. Sarcopenia was defined by RASM at <7.26 kg/m² and by the recent definition of the European Working Group on Sarcopenia in Older People (RASM at <7.26 kg/m(2) plus low muscle function). Linear regression was used to determine the associations between aLM, FM, muscle strength and BMD(a) and logistic regression to determine the association between sarcopenia and osteoporosis. RESULTS Six hundred seventy-nine men with a mean age of 59.6 (SD = 10.7), contributed data to the analysis; 11.9 % were sarcopenic by the conventional definition. After adjustment for age and centre, aLM, RASM and FM were positively associated with BMD(a). Men with RASM at <7.26 kg/m² had significantly lower BMD(a) compared with those with RASM at ≥7.26 kg/m(2). In a multivariable model, aLM was most consistently associated with BMD(a). Men with sarcopenia were more likely to have osteoporosis compared with those with normal RASM (odds ratio = 3.0; 95 % CI = 1.6-5.8). CONCLUSIONS Sarcopenia is associated with low BMD(a) and osteoporosis in middle-aged and elderly men. Further studies are necessary to assess whether maintaining muscle mass contributes to prevent osteoporosis.
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Affiliation(s)
- S Verschueren
- Research Group for Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Szulc P, Hofbauer LC, Rauner M, Goettsch C, Chapurlat R, Schoppet M. Serum myostatin levels are negatively associated with abdominal aortic calcification in older men: the STRAMBO study. Eur J Endocrinol 2012; 167:873-80. [PMID: 22968486 DOI: 10.1530/eje-12-0512] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the association between abdominal aortic calcification (AAC) and serum levels of myostatin, a negative regulator of skeletal muscle mass, which has been implicated in the development of atherosclerotic lesions in mice. DESIGN AND PATIENTS We assessed AAC semiquantitatively from the lateral spine scans obtained using dual energy X-ray absorptiometry in 1071 men aged 20-87 years. Serum myostatin levels were measured by an immunoassay that detects all myostatin forms. RESULTS Total myostatin serum levels did not differ between men with or without self-reported ischemic heart disease, hypertension, or diabetes mellitus. Total serum myostatin levels were higher in men with higher serum calcium levels and lower in men with higher serum concentrations of highly sensitive C-reactive protein. Men with AAC had lower myostatin levels compared with men without AAC. Prevalence of AAC (AAC score > 0) was lower in the highest myostatin quartile compared with the three lower quartiles (P < 0.05). After adjustment for confounders, odds of AAC (AAC score > 0) were lower (OR=0.62; 95% confidence interval (95% CI), 0.45-0.85; P< 0.005) for the fourth myostatin quartile vs the three lower quartiles combined. In the sub-analysis of 745 men aged 60 years, the results were similar: AAC prevalence was lower in the highest myostatin quartile compared with the three lower quartiles combined (OR=0.54; 95% CI, 0.38-0.78; P<0.001). CONCLUSIONS In older men, total myostatin serum levels are inversely correlated with AAC. Further studies are needed to investigate mechanisms underlying this association and to assess utility of myostatin as a cardiovascular marker.
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Affiliation(s)
- P Szulc
- INSERM UMR 1033, University of Lyon, F-69437 Lyon, France
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Blaizot S, Boutroy S, Vilayphiou N, Boonen S, Chapurlat R, Szulc P. Poor bone microarchitecture in older men with impaired physical performance--the STRAMBO study. Osteoporos Int 2012; 23:2785-96. [PMID: 22290241 DOI: 10.1007/s00198-012-1906-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 01/09/2012] [Indexed: 01/23/2023]
Abstract
UNLABELLED In 810 men ≥ 60 years, poor physical performance of lower limbs was associated with lower areal bone mineral density (aBMD) of total hip and poor bone microarchitecture at the distal tibia (assessed by HR-pQCT). Men who reported falls had lower hip aBMD and lower cortical density at the distal tibia. INTRODUCTION The aim of this study was to assess the association between bone microarchitecture and physical performance in older men. METHODS Volumetric bone mineral density (vBMD) and bone microarchitecture were assessed in 810 men ≥ 60 years at the distal radius and tibia by high resolution pQCT. aBMD was measured at the spine, hip, whole body, and distal radius by dual energy X-ray absorptiometry. Clinical tests included chair stands and tests of static and dynamic balance. We calculated a composite score summarizing abilities and time required to perform the tests. RESULTS In multivariable models, men who failed in ≥ one test had lower total hip aBMD than men who accomplished all the tests. They had lower total vBMD (Tt.vBMD), cortical thickness (Ct.Th), trabecular vBMD (Tb.vBMD), and more heterogenous trabecular distribution (Tb.Sp.SD) at the distal tibia (p < 0.05). Men who failed in ≥ two tests had lower aBMD at the total hip, femoral neck, and trochanter as well as lower Tt.vBMD, cortical vBMD (Ct.vBMD), Ct.Th and trabecular number (Tb.N), and higher Tb.Sp.SD at the distal tibia (p < 0.05). Men in the lowest quartile of the composite score had lower aBMD (total hip, distal radius), lower Tb.vBMD and Tb.N at the distal radius, and lower Tt.vBMD, Ct.vBMD, Ct.Th, Tb.vBMD, and Tb.N, and higher Tb.Sp.SD at the distal tibia compared with the highest quartile. In multivariables models, men reporting falls had lower total hip aBMD and lower distal tibia Ct.vBMD (p < 0.01). CONCLUSION In older men, poor physical performance is associated with lower hip aBMD and poor bone microarchitecture (mainly at the distal tibia).
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Affiliation(s)
- S Blaizot
- INSERM UMR 1033, Université de Lyon, Lyon, France
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Rolland T, Boutroy S, Vilayphiou N, Blaizot S, Chapurlat R, Szulc P. Poor trabecular microarchitecture at the distal radius in older men with increased concentration of high-sensitivity C-reactive protein--the STRAMBO study. Calcif Tissue Int 2012; 90:496-506. [PMID: 22527204 DOI: 10.1007/s00223-012-9598-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/19/2012] [Indexed: 01/08/2023]
Abstract
Low-grade inflammation, assessed by serum high-sensitivity C-reactive protein (hsCRP) concentration, is associated with higher fracture risk irrespective of areal bone mineral density (aBMD). We assessed the association of hsCRP with bone microarchitecture (measured by high-resolution pQCT) at the distal radius and tibia in 1,149 men, aged 19-87 years. hsCRP concentration increased with age until the age of 72, then remained stable. aBMD was not correlated with hsCRP level. After adjustment for confounders, bone microarchitecture was not associated with hsCRP level in men aged <72. After the age of 72, hsCRP >5 mg/L was associated with lower trabecular density, lower trabecular number, higher trabecular spacing, and more heterogeneous trabecular distribution (p < 0.05-0.005) at the distal radius versus hsCRP ≤ 5 mg/L. Similar differences were found for the fourth hsCRP quartile (>3.69 mg/L) versus the three lower quartiles combined. Cortical parameters of distal radius and microarchitectural parameters of distal tibia did not vary according to hsCRP concentration in men aged ≥ 72. Fracture prevalence increased with increasing hsCRP level. After adjustment for confounders (including aBMD), odds for fracture were higher in men with hsCRP >5 mg/L compared to hsCRP <1 mg/L (OR = 2.22, 95 % CI 1.29-3.82) and did not change after additional adjustment for microarchitectural parameters. The association between hsCRP level and bone microarchitecture was observed only for trabecular parameters at the radius in men aged ≥72. Impaired bone microarchitecture does not seem to explain the association between elevated CRP level and higher risk of fracture.
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Affiliation(s)
- T Rolland
- INSERM UMR 1033, Université de Lyon and Hospices Civils de Lyon, Lyon, France
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33
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Schoppet M, Hofbauer LC, Brinskelle-Schmal N, Varennes A, Goudable J, Richard M, Hawa G, Chapurlat R, Szulc P. Serum level of the phosphaturic factor FGF23 is associated with abdominal aortic calcification in men: the STRAMBO study. J Clin Endocrinol Metab 2012; 97:E575-83. [PMID: 22319041 DOI: 10.1210/jc.2011-2836] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Calcification inhibitor deficiencies, mineral imbalance, and phenotypic transformation of vascular cells to osteogenic cells initiate and sustain vascular calcification. Fibroblast growth factor-23 (FGF23) is a key molecule regulating mineral homeostasis. OBJECTIVE Our objective was to assess the association of serum FGF23 levels with mineral metabolism parameters and abdominal aortic calcification (AAC) in men. DESIGN This was a cross-sectional analysis in the STRAMBO cohort. SETTING Men holding a private health insurance cover with Mutuelle de Travailleurs de la Région Lyonnaise were included in the study. PARTICIPANTS Participants included male volunteers aged 20-87 (n = 1130). INTERVENTIONS Nonfasting blood collection was done. AAC was semiquantitatively assessed from vertebral fracture assessment scans obtained using dual-energy x-ray absorptiometry. MAIN OUTCOME MEASURES We evaluated the association between FGF23 concentration and AAC severity in men. RESULTS In 350 men aged 60 yr or younger, FGF23 levels decreased with age (r = -0.21; P < 0.001) but were not associated with any other parameter. In 780 men aged over 60 yr, serum FGF23 correlated with age (r = 0.37; P < 0.001) and, after adjustment for confounders, with glomerular filtration rate (r = -0.31; P < 0.001) and PTH levels (r = 0.25; P < 0.001). After adjustment for confounders, self-reported ischemic heart disease, diabetes mellitus as well as higher concentrations of C-reactive protein and osteoprotegerin were all associated with higher FGF23 levels. After adjustment for confounders, subjects in the highest FGF23 quartile had higher prevalence of severe AAC compared with the three lower quartiles combined (odds ratio = 1.88; 95% confidence interval = 1.22-2.85; P < 0.005). CONCLUSIONS In healthy older men, circulating FGF23 is associated with parameters of mineral metabolism, including bone metabolism-regulating cytokines, and with severe AAC independent of traditional risk factors.
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Affiliation(s)
- M Schoppet
- Department of Internal Medicine and Cardiology, Philipps-University, Marburg D-35043, Germany
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Szulc P, Lewandowski J, Boch-Kmieciak J, Berski P, Matusiak M. The objective evaluation of effectiveness of manual treatment of spinal function disturbances. Med Sci Monit 2012; 18:CR316-22. [PMID: 22534712 PMCID: PMC3560620 DOI: 10.12659/msm.882738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this paper is the evaluation of effectiveness of manual therapy in the treatment of functional disturbances of the spine. Material/Methods The study subjects were 40 persons aged 45–60 years, in whom degenerative changes in intervertebral discs and physical limitations within the spine were found (NMR), which were manifested as pain. Subjects were randomly divided into 2 groups of 20 persons each. The first group went on a monthly rehabilitation tour, where the manual therapy methods were applied. The second group was treated by means of physical methods. In order to verify the results of effectiveness of the therapies, the examination of the sectional mobility and the evaluation of the spinal curvatures before and after the completion of the therapy were made by means of a tensiometric electrogoniometer. Results The percentage differences in significance result from the lower value of parameter t1 in the group of persons treated physically. The dynamics of changes in the parameters in the sectional mobility in both tested groups was highest in the cervical and lumbar spine. The manually treated group had greater dynamics of changes in functional parameters of the spine. Conclusions Manual therapy is an effective method for treatment of functional changes and early structural changes within the spine, and may be used as supplementary therapy in relation to the standard model of treatment of spinal pain.
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Affiliation(s)
- Paweł Szulc
- Chair of Functional Anatomy, University of Physical Education in Poznan, Poznan, Poland
| | - Jacek Lewandowski
- Department of Kinesitherapy, University of Physical Education in Poznan, Poznan, Poland
| | - Joanna Boch-Kmieciak
- Chair of Functional Anatomy, University of Physical Education in Poznan, Poznan, Poland
| | - Paweł Berski
- Chair of Functional Anatomy, University of Physical Education in Poznan, Poznan, Poland
| | - Marta Matusiak
- Chair of Functional Anatomy, University of Physical Education in Poznan, Poznan, Poland
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Szulc P, Feyt C, Chapurlat R. Determinants of low muscle strength and poor physical performance in older men – the STRAMBO Study. Journal of Men's Health 2011. [DOI: 10.1016/j.jomh.2011.08.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Szulc P, Debiesse E, Boutroy S, Vilauphiou N, Chapurlat R. Poor trabecular microarchitecture in male current smokers: the cross-sectional STRAMBO study. Calcif Tissue Int 2011; 89:303-11. [PMID: 21800164 DOI: 10.1007/s00223-011-9519-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 06/29/2011] [Indexed: 12/19/2022]
Abstract
Current smoking (but not past smoking) is associated with higher risk of fracture independent of areal bone mineral density (aBMD); however, the pathophysiologic mechanism underlying this association is not clear. In 810 men aged 60-87, aBMD was measured by dual-energy X-ray absorptiometry. Bone microarchitecture at the distal radius and distal tibia was assessed by high-resolution peripheral quantitative computed tomography using the Xtreme CT Scanco device. Current smokers (n = 47) had lower trabecular volumetric density (Dtrab), lower trabecular number (TbN), more heterogenous trabecular network (higher trabecular spacing standard deviation [TbSpSD]), as well as higher urinary deoxypyridinoline and higher C-reactive protein levels in comparison with 261 men who never smoked (adjusted for age, weight, height, time spent outdoors, physical activity, and intake of alcohol, caffeine, and calcium). Abnormal values (lower Dtrab and TbN, higher TbSpSD, deoxypyridinoline, and C-reactive protein) were found mainly in 21 current smokers who smoked eight or more cigarettes per day. Cortical parameters and aBMD did not differ from the never-smokers. In 502 former smokers, aBMD and all bone microarchitectural parameters did not differ from the never-smokers. At the tibia (not radius), Dtrab decreased, whereas TbSpSD slightly increased across quartiles of smoking intensity (number of pack-years). In conclusion, older men who are moderate current smokers have poor trabecular (but not cortical) microarchitecture, which is not reflected by a decrease in aBMD.
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Affiliation(s)
- P Szulc
- INSERM Research Unit, Hôpital Edouard Herriot, Université de Lyon, Place d'Arsonval, France.
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Szulc P, Hawa G, Boutroy S, Vilayphiou N, Schoppet M, Chapurlat R, Hofbauer LC. Cortical bone status is associated with serum osteoprotegerin concentration in men: the STRAMBO study. J Clin Endocrinol Metab 2011; 96:2216-26. [PMID: 21565793 DOI: 10.1210/jc.2010-2617] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Osteoprotegerin (OPG) is an inhibitor of bone resorption, but its relationship to bone microarchitecture remains unclear. OBJECTIVE Our objective was to study the relationship between OPG concentration and bone microarchitecture in men. DESIGN, SETTING, AND PARTICIPANTS We conducted a cross-sectional study of a population-based cohort of 1149 men aged 20-87 yr. INTERVENTIONS We assessed bone microarchitecture at the distal radius and tibia by high-resolution peripheral quantitative computed tomography (XtremeCT Scanco) and measured serum OPG concentration and bone turnover markers: osteocalcin, bone-specific alkaline phosphatase, N-terminal extension type I collagen propeptide, C-terminal type 1 collagen telopeptide, and urinary deoxypyridinoline. MAIN OUTCOME MEASURES Differences were assessed in bone microarchitectural parameters across the OPG quartiles in the models adjusted for age, weight, height, physical activity, ischemic heart disease, diabetes mellitus, calcium intake, serum levels of free testosterone, bioavailable 17β-estradiol, PTH, 25-hydroxycholecalciferol, and creatinine. RESULTS After adjustment for the confounders, men in the highest (fourth) quartile of OPG levels (>4.55 pmol/liter) had higher total cross-sectional area and trabecular area at the distal radius and distal tibia (3.3-6.0%, P < 0.05). At both skeletal sites, the highest OPG quartile was associated with lower cortical thickness (8.2%, P < 0.001, and 3.7%, P < 0.05) and volumetric bone mineral density (vBMD, 2.7%, P < 0.001, and 1.6%, P < 0.005) compared with the three lower quartiles combined. Associations of OPG level with trabecular vBMD, number, thickness, and distribution were not significant. Men in the fourth OPG quartile had higher levels of bone resorption markers (11.8-13.1%, P < 0.01-0.001). CONCLUSIONS Men with higher serum OPG concentration had lower cortical thickness and vBMD, probably due to accelerated endo- and intracortical bone turnover, but higher cross-sectional area possibly due to periosteal apposition.
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Affiliation(s)
- P Szulc
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1033, University of Lyon, Hospices Civils de Lyon, 69437 Lyon, France.
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Chaitou A, Boutroy S, Vilayphiou N, Varennes A, Richard M, Blaizot S, Munoz F, Delmas PD, Goudable J, Chapurlat R, Szulc P. Association of bone microarchitecture with parathyroid hormone concentration and calcium intake in men: the STRAMBO study. Eur J Endocrinol 2011; 165:151-9. [PMID: 21490123 DOI: 10.1530/eje-11-0184] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED OBJECTVIE: In the elderly, vitamin D deficit, low calcium intake, and impaired bone microarchitecture are associated with higher risk of hip fracture. We assessed the association of bone microarchitecture with calcium intake and serum concentrations of 25-hydroxycholecalciferol (25OHD) and parathyroid hormone (PTH) in men. DESIGN Cross-sectional analysis was performed in 1064 men aged 20-87 years not taking vitamin D or calcium supplements. METHODS Daily calcium intake was assessed using a food frequency questionnaire. Bone microarchitecture was assessed at distal radius and tibia by high-resolution peripheral quantitative computed tomography. We measured serum and urinary levels of biochemical bone turnover markers (BTMs). Statistical models were adjusted for age, weight, height, and glomerular filtration rate. RESULTS In 500 men aged <65 years, lower 25OHD levels and low calcium intake were associated with lower trabecular volumetric bone mineral density (Dtrab) at the distal tibia, due to lower trabecular number (Tb.N). Low calcium intake was associated with lower cortical thickness (Ct.Th). Higher PTH level was associated with higher BTM levels. In 563 men aged ≥65 years, the highest PTH quartile was associated with lower Ct.Th (tibia), lower Dtrab (both sites), and lower Tb.N (radius) compared with the lowest quartile. Low calcium intake was associated with lower Tb.N and more heterogenous trabecular distribution. BTM positively correlated with the PTH concentration. CONCLUSION In older men, elevated PTH concentration is associated with high bone turnover, poor trabecular microarchitecture (radius and tibia), and, at the distal tibia, lower Ct.Th. Low calcium intake is associated with lower Tb.N and more heterogenous trabecular distribution.
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Affiliation(s)
- A Chaitou
- INSERM Research Unit 1033, Hôpital Edouard Herriot, Université de Lyon 1, Place d'Arsonval, 69437 Lyon, France
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Blaizot S, Delmas PD, Marchand F, Chapurlat R, Szulc P. Risk factors for peripheral fractures vary by age in older men--the prospective MINOS study. Osteoporos Int 2011; 22:1755-64. [PMID: 20838767 DOI: 10.1007/s00198-010-1386-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 08/24/2010] [Indexed: 12/11/2022]
Abstract
UNLABELLED Identification of older men at high risk of peripheral fracture can be improved by assessing prevalent fractures (men aged ≤ 65), history of falls (men aged >65), bone width, and aortic calcifications. INTRODUCTION Low bone mineral density (BMD) identifies 20% of men who sustain osteoporotic fracture. We studied (1) if the assessment of bone width, aortic calcifications, prevalent falls and fractures improves identification of men at high risk of fracture and (2) if the predictive value of these parameters varies with age. METHODS Among 781 men aged 50 and over, 61 men sustained 66 low-trauma peripheral fractures during 10 years. History of falls and prevalent fractures was assessed by questionnaire. BMD and bone with were measured by dual X-ray absorptiometry. Abdominal aortic calcifications were assessed on the lateral radiographs of the lumbar spine. RESULTS Low BMD, low bone width, extended aortic calcifications, prevalent fractures (mainly multiple fractures) and frequent falls were all associated independently with higher risk of fracture. In men aged ≤ 65, prevalent fractures are associated with a significant increase in the risk of fracture (two- to threefold for one and four- to fivefold for multiple prevalent fractures). In men aged >65, history of falls is associated with a higher risk of fracture, e.g. frequent falls are associated with a sixfold increase in the risk of fracture. CONCLUSIONS Men aged ≤ 65 with multiple prevalent fractures and frequent fallers aged >65 are at particularly high risk of peripheral fracture regardless of BMD.
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Affiliation(s)
- S Blaizot
- INSERM 831 Research Unit, Université de Lyon, Lyon, France
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Szulc P, Varennes A, Chapurlat R, Goudable J, Delmas P. Do Low Bone Mineral Density and Lower Fracture Risk in Men with Metabolic Syndrome Have Different Determinants? - the MINOS Study. Journal of Men's Health 2009. [DOI: 10.1016/j.jomh.2009.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Szulc P, Debiesse E, Boutroy S, Chapurlat R. Deterioration of the trabecular microarchitecture in moderate men smokers - the STRAMBO study. Journal of Men's Health 2009. [DOI: 10.1016/j.jomh.2009.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
INTRODUCTION Bone modeling and remodeling is the final common pathway expressing all genetic and environmental factors that influence the attainment and maintenance of bone's material and structural strength. Modeling and remodeling require a surface, and during growth this cellular machinery fashions bone's external size, shape, and internal architecture by depositing bone on, and removing bone from, both its periosteal (external) and endosteal (internal) envelopes. Bone is distributed and redistributed to achieve strength commensurate with its loading requirements. METHODS Advancing age is associated with: (1) a reduction in the volume of bone resorbed by each basic multicellular unit (BMU); (2) an even greater reduction in the volume of bone formed by each BMU so that each remodeling event, whether adaptive or reparative, removes bone from the bone; (3) increased remodeling (number of BMUs) on the three (endocortical, intracortical, and trabecular) components of its endosteal envelope in midlife in women and late in life in both sexes; and (4) reduced bone formation on the periosteal envelope. The net effect is cortical thinning, increased intracortical porosity, trabecular thinning, and loss of connectivity. RESULTS While remodeling intensity on an envelope determines structure (e.g., trabecular perforations), the surface area of the envelope determines remodeling intensity, and, so, structure. High remodeling on trabecular surfaces decreases as trabeculae (with their surface) are lost. Conversely, remodeling on the endocortical and intracortical envelopes increases their surface area, so remodeling intensity increases and bone loss becomes predominantly cortical. CONCLUSIONS Understanding bone structural strength and its decay and the effects of genetic factors, exercise, nutrition, and drug therapy on bone requires thinking outside and inside these envelopes; their absolute and relative movements during growth and aging determine bone structure and its strength.
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Affiliation(s)
- P Szulc
- INSERM 831 Research Unit, University of Lyon, Lyon, France
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Szulc P, Delmas PD. Biochemical markers of bone turnover: potential use in the investigation and management of postmenopausal osteoporosis. Osteoporos Int 2008; 19:1683-704. [PMID: 18629570 DOI: 10.1007/s00198-008-0660-9] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 04/28/2008] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The aim was to analyse data on the use of biochemical bone turnover markers (BTM) in postmenopausal osteoporosis. METHODS We carried out a comparative analysis of the most important papers concerning BTM in postmenopausal osteoporosis that have been published recently. RESULTS The BTM levels are influenced by several factors. They are moderately correlated with BMD and subsequent bone loss. Increased levels of bone resorption markers are associated with a higher risk of fracture. Changes in the BTM during the anti-osteoporotic treatment (including combination therapy) reflect the mechanisms of action of the drugs and help to establish their effective doses. Changes in the BTM during the anti-resorptive treatment are correlated with their anti-fracture efficacy. CONCLUSION Biological samples should be obtained in a standardised way. BTM cannot be used for prediction of the accelerated bone loss at the level of the individual. BTM help to detect postmenopausal women who are at high risk of fracture; however, adequate practical guidelines are lacking. BTM measurements taken during the anti-resorptive therapy help to identify non-compliers. They may improve adherence to the anti-resorptive therapy and the fall in the BTM levels that exceeds the predefined threshold improves patients' persistence with the treatment. There are no guidelines concerning the use of BTM in monitoring anti-osteoporotic therapy in postmenopausal women.
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Affiliation(s)
- P Szulc
- INSERM Research Unit 831, Hôpital Edouard Herriot, Lyon, France.
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Szulc P, Bartkowiak P, Lewandowski J, Markuszewski J. [The influence of idiopathic scoliosis on load distribution in the foot]. Chir Narzadow Ruchu Ortop Pol 2008; 73:187-191. [PMID: 18847025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Pedobarography is used more and more often in such fields as orthopaedics, traumatology, neurology, diabetology or rehabilitation. The aim of this work has been to evaluate the effects of right-side idiopathic thoracic scolioses and changes in angular values of physiological curvatures of the spine on sub-pedal pressure distribution. TWINN 99 software assisted PEL-38 measuring platform and Penny & Giles tensiometric electrogoniometre were used in the study which was carried out on the population of 30 girls with right-side idiopathic thoracic scoliosis. The girls exhibited a mild degree of scoliosis. The control was made up of a group of 30 healthy girls with no musculoskeletal system pathology. The girls in both groups were 10 years old. Measurements of spinal curvatures and distribution of sub-pedal pressure forces were carried out three times daily, always at the same time. The analysis of the results has shown that right-side idiopathic thoracic scoliosis leads to higher pressure being imposed on the halux and convex front part of the foot. Such pressure distribution stems from flattening of the thoracic kyphosis and enhancement of lumbar lordosis. The shift of the gravity centre to the front and to the right can as a result exacerbate the pathology not only in the foot, but also in the whole lower limb at the scoliotic side.
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Affiliation(s)
- Paweł Szulc
- Katedra Anatomii Funkcjonalnej, Akademia Wychowania Fizycznego im. Eugeniusza Piaseckiego w Poznaniu
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Szulc P, Montella A, Delmas PD. High bone turnover is associated with accelerated bone loss but not with increased fracture risk in men aged 50 and over: the prospective MINOS study. Ann Rheum Dis 2007; 67:1249-55. [PMID: 18065499 DOI: 10.1136/ard.2007.077941] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The association of bone turnover markers (BTM) with bone loss and fracture risk in men is poorly studied. The morphological basis of such a relationship is unknown. The objective of this study was to evaluate the association between baseline BTM levels and subsequent bone loss and fracture risk in men. METHODS This study is a prospective 7.5-year follow-up of the cohort composed of 723 men aged 50-85 years. Serum concentrations of osteocalcin, bone alkaline phosphatase (BAP), procollagen type I N-terminal propeptide, C-terminal telopeptide of type I collagen (beta-CTX-I) and urinary excretion of deoxypyridinoline and beta-CTX-I were measured at baseline. Every 18 months, incident fractures were recorded and bone mineral density (BMD) was measured by dual energy x ray absorptiometry DXA (spine, hip, distal forearm, whole body). RESULTS Increase in BTM levels was associated with faster bone loss at the level of the trochanter, whole body and distal forearm. At the level of the distal radius and the ulna, increase in the serum BAP and beta-CTX-I levels were associated with faster apparent, net and estimated endosteal bone mineral loss. BTM levels did not correlate with the periosteal expansion rate. BTMs were significantly associated with bone mineral loss but their predictive power was poor. BTMs did not predict incident fractures. CONCLUSIONS In men aged 50 and over, accelerated bone turnover is associated with greater endosteal bone mineral loss. From a practical point of view, BTMs cannot be used for the prediction of accelerated bone loss or fractures in the clinical management of osteoporosis in men.
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Affiliation(s)
- P Szulc
- INSERM Research Unit 831, Hôpital Edouard Herriot, Pavillon F, 69437 Lyon, France.
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Abstract
UNLABELLED Osteoporosis in men is less studied than in women. Few data concern biochemical bone turnover markers (BTM) in men and their potential use. METHODOLOGY We evaluated papers concerning BTM in men cited on Medline. Selection of studies were based on the number of subjects, age range, group homogeneity, follow-up duration, number of BTM. RESULTS BTM levels are high in young men, then decrease with age. In elderly men, bone resorption increases with age more than bone formation. Variability of individual values is high and their significance is unclear. In elderly men, BTM levels correlate negatively with bone mineral density suggesting that accelerated bone turnover underlies age-related bone loss. Data on the prediction of accelerated bone loss and fractures by BTM in men are scant. Testosterone treatment induces a decrease in bone resorption followed by a decrease in bone formation. Bisphosphonates and calcitonin decrease BTM levels in osteoporotic men. Parathyroid hormone 1-34 and growth hormone induce a rapid increase in bone turnover followed by a progressive slowdown. CONCLUSIONS Few studies concern BTM in men. Currently available data are not sufficient to suggest guidelines for the practical use of BTM in the clinical management of the osteoporosis in elderly men.
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Affiliation(s)
- P Szulc
- INSERM Research Unit 831, University of Lyon, Lyon, France.
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Szulc P, Delmas PD. Bone loss in elderly men: increased endosteal bone loss and stable periosteal apposition. The prospective MINOS study. Osteoporos Int 2007; 18:495-503. [PMID: 17253119 PMCID: PMC1820756 DOI: 10.1007/s00198-006-0254-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 10/06/2006] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Longitudinal studies on the age-related bone loss in men concerns the decrease in areal bone mineral density (aBMD), which can be qualified as "apparent bone loss" because it does not reflect the change in bone mineral content (BMC). Loss of BMC can be referred to as "net bone loss" because it does not take into account the morphological basis of the bone loss (decreased periosteal apposition; endosteal bone loss, i.e. bone loss on the trabecular, endocortical and intracortical surfaces). The aim of this study was to assess age-related apparent net and endosteal bone loss as well as their morphological basis and age-related changes during a prospective follow-up in a large cohort of elderly men. METHODS This analysis was performed in 725 men aged 51-85 at baseline who were followed up for 90 months. RESULTS Bone densitometry was carried out at the lumbar spine, hip and whole body by using the HOLOGIC QDR1500 device and at the distal forearm by using the Osteometer DTX100 device. Sixty-five men who abandoned the study after the first examination were older and had lower aBMC at most sites of measurement. Apparent bone loss was significant at the hip, distal forearm and whole body. Net bone loss was also significant at these sites, except for the femoral neck. Periosteal expansion was significant at all sites of measurement. Apparent and net bone loss accelerated with age, whereas the rate of periosteal expansion remained stable. At the distal radius and ulna, endosteal bone loss accelerated with age, whereas the rate of periosteal apposition remained stable. CONCLUSION In a large cohort of elderly men, age-related apparent bone loss (aBMD) at the hip, distal forearm and whole body was determined by the net bone loss (BMC), except for the femoral neck. Apparent and net bone loss accelerated with age, whereas the periosteal expansion rate (bone widening) remained constant. At the distal forearm, age-related acceleration of the apparent bone loss was determined by the higher endosteal bone loss, whereas the periosteal apposition rate (estimated mass of deposited bone) remained constant.
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Affiliation(s)
- P Szulc
- INSERM Research Unit 403, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France.
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Szulc P, Delmas PD. Bone width is correlated positively with the upper to the lower segment ratio in elderly men--the MINOS study. Bone 2007; 40:194-9. [PMID: 16920052 DOI: 10.1016/j.bone.2006.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Revised: 07/05/2006] [Accepted: 07/07/2006] [Indexed: 11/21/2022]
Abstract
Before puberty, limbs grow more rapidly than the spine. During puberty, lengthening of the spine and increase in bone width accelerate. Correlation of parameters with lengths of the upper and lower segments and with the upper/lower segment ratio may indicate the period of growth critical for their determination. We assessed the association of bone mineral and width with the upper/lower segment ratio in 542 elderly men from the MINOS cohort. Areal bone mineral density (aBMD) was measured at the lumbar spine and right hip using pencil-beam dual-energy X-ray absorptiometry and at the distal forearm using single energy X-ray absorptiometry. Upper/lower segment ratio correlated positively with bone mineral content (BMC), aBMD and width of third lumbar vertebra (L3), femoral neck and distal radius. Men in the highest quartile of the upper/lower segment ratio had larger bones by 2.5 to 5.0% (0.3-0.4 SD, p<0.02-0.002) compared with the lowest quartile. Bone width correlated more strongly with the upper segment length than with that of the lower one. Volumetric BMD (vBMD) did not correlate with the upper/lower segment ratio nor with the lengths of the body segments. At the femoral neck and distal radius, men in the highest quartile of the upper/lower segment ratio had higher estimated cortical thickness (5.3%, 0.41 SD, p<0.01 and 4.0%, 0.31 SD, p<0.03), bigger cortical area (8.0%, 0.54 SD and 6.8%, 0.52 SD, p<0.0001) and higher estimated bending strength (9.3 to 13.3%, 0.46 to 0.54 SD, p<0.0001). Elderly men with the higher upper/lower segment ratio had higher BMC and bending strength because they had wider bones, not higher vBMD. The bone size correlated positively with the length of the upper segment, not negatively with that of the lower segment. Our data may suggest an important role of pubertal growth for both bone width and strength in men but do not establish the determinants of this association. Given methodological limitations, these results need to be confirmed in a younger and more representative group of men.
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Affiliation(s)
- P Szulc
- INSERM Research Unit 403, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437 Lyon, France.
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Szulc P, Duboeuf F, Schott AM, Dargent-Molina P, Meunier PJ, Delmas PD. Structural determinants of hip fracture in elderly women: re-analysis of the data from the EPIDOS study. Osteoporos Int 2006; 17:231-6. [PMID: 15983728 DOI: 10.1007/s00198-005-1980-7] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Accepted: 06/15/2005] [Indexed: 10/25/2022]
Abstract
Hip fracture is the most disastrous osteoporotic fracture, characterized by high mortality, morbidity and institutionalization for the patient and by high economic costs for the health care system. The morphology of the upper part of the femur can influence the risk of hip fracture, e.g., a longer femoral neck is associated with a higher risk of cervical fractures, but not trochanteric ones. In this study, we evaluated the prediction of hip fracture risk by morphological parameters estimated from DXA measurements, and we compared their predictive value for cervical and trochanteric fractures in elderly women by reanalyzing previously published data (Duboeuf et al. J Bone Miner Res 1997 12 1895). This nested case-control study was performed in 232 elderly community-dwelling women from the EPIDOS cohort, including 65 women who sustained a hip fracture. After adjustment for confounding variables, women who sustained a cervical fracture had lower areal bone mineral density (aBMD), lower cortical thickness and a higher average buckling ratio (P<0.005 for all) as well as longer femoral neck (P<0.01) than controls. Women who sustained a trochanteric fracture had lower aBMD, lower cortical thickness and higher buckling ratio than controls (P<0.0001) and than women who sustained a cervical fracture (P<0.05). Their bending resistance (cross-sectional moment of inertia-CSMI, section modulus) was significantly lower in comparison with controls (P<0.05-0.001). A decrease in aBMD, cortical thickness, CSMI and section modulus as well as an increase in buckling ratio were predictive of all hip fractures (OR -1.42-2.46 per 1 SD, P<0.05-0.0001), but the ORs for all structural parameters were markedly higher for trochanteric than for cervical fractures. CSMI and section modulus were predictive of trochanteric, but not cervical fractures. However, aBMD was strongly correlated with the CSA, cortical thickness and buckling ratio (r2>0.74), which suggests that they convey the same information. CSMI and section modulus correlated with aBMD more weakly, but their OR lost statistical significance after adjustment for aBMD. In conclusion, low femoral neck aBMD, CSA and cortical thickness as well as a high buckling ratio are associated with the higher risk of hip fracture, especially trochanteric ones. These indices are highly correlated with aBMD and convey the same message. The calculated CSMI and section modulus predict trochanteric fractures, but not cervical fractures, and their statistical significance is lost after adjustment for aBMD, indicating that they reflect mainly aBMD, not mechanical properties. Thus, the independent contribution of the external diameter of the femoral neck to the risk of hip fracture cannot be reliably estimated by this technique.
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Affiliation(s)
- P Szulc
- INSERM 403 Research Unit, Hôpital Edouard Herriot, Pavillon F Place d'Arsonval, 69437, Lyon, France.
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Szulc P, Garnero P, Marchand F, Duboeuf F, Delmas PD. Biochemical markers of bone formation reflect endosteal bone loss in elderly men--MINOS study. Bone 2005; 36:13-21. [PMID: 15663998 DOI: 10.1016/j.bone.2004.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Revised: 08/09/2004] [Accepted: 09/10/2004] [Indexed: 11/15/2022]
Abstract
In the skeleton of elderly men, two opposite activities occur: bone loss at the endosteal envelope, which increases bone fragility, and periosteal apposition, which improves bending strength of bone. Both may contribute to serum bone formation markers although they have an opposite effect on bone fragility. The aim of this study was to determine if circulating bone formation markers reflect periosteal bone formation and endosteal bone remodelling in 640 men aged 55-85 years belonging to the MINOS cohort. We measured biochemical markers of bone formation (osteocalcin, bone alkaline phosphatase, N-terminal extension propeptide of type I collagen) and bone resorption (urinary and serum beta-isomerised C-terminal telopeptide of collagen type I, total and free deoxypyridinoline). Parameters of bone size (cross-sectional surface of third lumbar vertebral body measured by X-ray, projected areas of total hip, femoral neck, radius and ulna measured by dual-energy X-ray absorptiometry) increased with age (r = 0.20-0.32, P < 0.0001). In contrast, parameters related to bone loss (areal bone mineral density [aBMD], volumetric bone mineral density [vBMD] and cortical thickness) and determined mainly by bone resorption, decreased with ageing (r = -0.14 to -0.23, P < 0.005-0.0001). Men in the highest quartile of bone resorption markers had lower aBMD (3.8-10.2%, P < 0.05-0.0001), lower vBMD (3.9-13.0%, P < 0.05-0.0001), and lower cortical thickness (1.5-9.6%, P < 0.05-0.0001) than men in the lowest quartile. Markers of bone resorption were not significantly associated with estimates of bone size at any skeletal site. Markers of bone formation were not associated with estimates of periosteal formation after adjustment for covariates. In contrast, men in the highest quartile of the bone formation markers had significantly lower aBMD (4.0-11.7%, P < 0.05-0.0001), lower vBMD (4.2-16.3, P < 0.05-0.0001) and lower cortical thickness (4.0-7.4%, P < 0.05-0.0001) than men in the lowest quartile. In summary, serum levels of bone formation markers are negatively correlated with the estimates of endosteal bone loss. In contrast, they disclose no association with parameters reflecting periosteal apposition. Thus, in elderly men, bone formation markers reflect endosteal bone remodelling, probably because of the coupling between resorption and formation activities. In contrast, they do not reflect the periosteal bone formation, probably because the periosteal surface is smaller and has a slower remodelling rate than the endosteal surface.
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Affiliation(s)
- P Szulc
- INSERM 403 Research Unit, Hôpital Edouard Herriot, Claude Bernard University, Lyon, France
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